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General Considerations they ask authors to cite electronic references within paren- Authors should provide direct references to original theses in the text or in numbered references following the research sources whenever possible generic gyne-lotrimin 100mg fast delivery. Authors should consult with the journal to which they be used by authors discount gyne-lotrimin 100 mg on-line, editors buy 100 mg gyne-lotrimin with mastercard, or peer reviewers to promote plan to submit their work gyne-lotrimin 100 mg lowest price. Although references to review articles can be an efficient way to guide readers to a body of literature, review articles do not always reflect original work accu- rately. References to papers accepted but not yet published updated as new media develop, and currently include guid- should be designated as “in press” or “forthcoming. Published articles should reference the unique, persis- tent identifiers of the datasets employed. Tables provides essential information not available from a public Tables capture information concisely and display it source, in which case the name of the person and date of efficiently; they also provide information at any desired communication should be cited in parentheses in the text. Including data in tables rather For scientific articles, obtain written permission and con- than text frequently makes it possible to reduce the length firmation of accuracy from the source of a personal com- of the text. Prepare tables according to the specific journal’s re- Some but not all journals check the accuracy of all quirements; to avoid errors it is best if tables can be directly reference citations; thus, citation errors sometimes appear imported into the journal’s publication software. To minimize such er- tables consecutively in the order of their first citation in the rors, references should be verified using either an electronic text and supply a title for each. Titles in tables should be bibliographic source, such as PubMed, or print copies from short but self-explanatory, containing information that al- original sources. Authors are responsible for checking that lows readers to understand the table’s content without hav- none of the references cite retracted articles except in the ing to go back to the text. Explain all nonstandard abbreviations in [pt]”, where the term “pt” in square brackets stands for footnotes, and use symbols to explain information if publication type, or by going directly to the PubMed’s list needed. References should be numbered consecutively in the Identify statistical measures of variations, such as standard order in which they are first mentioned in the text. Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals If you use data from another published or unpublished j. Units of Measurement source, obtain permission and acknowledge that source Measurements of length, height, weight, and volume fully. Blood the electronic version of the journal, deposited with an pressures should be in millimeters of mercury, unless other archival service, or made available to readers directly by the units are specifically required by the journal. An appropriate statement should be added to the Journals vary in the units they use for reporting hema- text to inform readers that this additional information is tologic, clinical chemistry, and other measurements. Submit such tables for thors must consult the Information for Authors of the par- consideration with the paper so that they will be available ticular journal and should report laboratory information in to the peer reviewers. Abbreviations and Symbols print submissions, figures should be either professionally Use only standard abbreviations; use of nonstandard drawn and photographed, or submitted as photographic- abbreviations can be confusing to readers. The spelled-out abbre- For radiological and other clinical and diagnostic im- viation followed by the abbreviation in parenthesis should ages, as well as pictures of pathology specimens or photo- be used on first mention unless the abbreviation is a stan- micrographs, send high-resolution photographic image dard unit of measurement. Sending the Manuscript to the Journal same intensity, direction, and color of light. Since blots are Manuscripts should be accompanied by a cover letter used as primary evidence in many scientific articles, editors or a completed journal submission form, which should in- may require deposition of the original photographs of blots clude the following information: on the journal’s website. A full statement to the editor about all submissions and Although some journals redraw figures, many do not. Any such work should be clear and consistent throughout, and large enough to be referred to specifically and referenced in the new paper. Copies of such material should be included with the sub- Figures should be made as self-explanatory as possible, mitted paper to help the editor address the situation. Titles and detailed explanations belong in the legends— A statement of financial or other relationships that might not on the illustrations themselves. Journals that do not use internal scale and identify the method of staining in pho- contribution declarations for all authors may require tomicrographs. If a thors, that the requirements for authorship as stated figure has been published previously, acknowledge the earlier in this document have been met, and that each au- original source and submit written permission from the thor believes that the manuscript represents honest work if copyright holder to reproduce it. Contact information for the author responsible for In the manuscript, legends for illustrations should be communicating with other authors about revisions and fi- on a separate page, with Arabic numerals corresponding to nal approval of the proofs, if that information is not in- the illustrations. Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals bodies) regarding the conduct of the research or if correc- Many journals provide a presubmission checklist to tive action has been recommended. The letter or form help the author ensure that all the components of the sub- should give any additional information that may be helpful mission have been included. Some journals also require to the editor, such as the type or format of article in the that authors complete checklists for reports of certain study particular journal that the manuscript represents. Authors should look to see nal, it is helpful to include the previous editor’s and review- if the journal uses such checklists, and send them with the ers’ comments with the submitted manuscript, along with manuscript if they are requested. Editors encour- The manuscript must be accompanied by permission to age authors to submit these previous communications. Do- reproduce previously published material, use previously pub- ing so may expedite the review process and encourages lished illustrations, report information about identifiable per- transparency and sharing of expertise. With the help of extensive population information this research intends to show how different concepts and measurements produce very different pictures of health and ill health. The concept trilogy of illness, disease, and sickness is used to capture different aspects of ill health. Design: Cross sectional data were obtained through comprehensive interview surveys 1988–2001 and See end of article for registers of sickness absence. Correspondence to: Main results: Most people have some sort of illness or complaint. There also was an obvious discrepancy for Work and Health, between reporting having a disease and a subject’s rating of general health. It was shown that the different National Institute for Working Life, 113 91 concepts showed different trends over time. Stockholm, Sweden; Conclusions: The discrepancies between the concepts imply that you have to be very careful when using anders. The comparatively low degree of overlap Accepted for publication between them shows that they represent different realities. There is a need to do further empirical research 18 January 2005 about how different aspects of morbidity are interrelated. Differences Sickness is related to a different phenomenon, namely the may be related to methodological context, for example social role a person with illness or sickness takes or is given in because they are based on different sources of data (from society, in different arenas of life. One type of data registers or surveys),12or on different informants (physicians concerning a more limited aspect of sickness is that relating or patients). Such data are often used to theoretical context, concerning for example their focus measure social consequences for the person of ill (medical symptoms or social consequences for the person). Here we intend to deepen the discussion and use that a person who does not feel well, is diagnosed by a empirical data to show differences between different mea- physician, and then, if the problems are serious and affect sures taken from the same population. In reality, however, things The concept trilogy of illness, disease, and sickness, are not this simple. In some forms of experienced illness the has been used to capture different aspects of ill health, and person never bothers to have the condition confirmed by a here we will apply the following, generally used, definitions physician, either because the problem is too small or because of them. Some illnesses and diseases identifies themselves with, often based on self reported do not lead to sickness and most illnesses and diseases do not mental or physical symptoms. In some cases this may mean lead to sickness absence, either because they do not lead to a only minor or temporary problems, but in other cases self reduction in the work capacity needed, or the person may still reported illness might include severe health problems or choose to work, that is to be sickness present. According to this in a complex way, we have a fourth one—the concept of definition illness is seen as a rather wide concept. The concept of health has been defined and under- Disease, on the other hand, is defined as a condition that is stood in many different ways. Ideally, this opposite of illness or disease, so that the more you have of would include a specific diagnosis according to standardised illness or disease, the less you have of health and vice versa. This would in most cases In the past decade however, health has often been under- also mean that the specific condition has a known biomedical stood to belong to a completely different dimension from cause and often known treatments and cures. In should be mentioned that there are several limitations to this this tradition various definitions of health are used, for ideal in practice. One is the fact that a number of medical instance health is defined as wellbeing, or as capacity to act diagnoses have to be based on subjective information from to reach vital goals, or the possibility of experiencing the patient concerning pains and feelings. Because the questionnaires differed from year to year all years could not Disease be included in some cases. Register data from the National Social Security Board was obtained for the same people concerning the number of Sickness compensated sick leave days during that year.

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However cheap gyne-lotrimin 100 mg on line, two double-blind buy discount gyne-lotrimin 100mg, placebo-controlled trials of anthocyanins in healthy volunteers failed to show improved night visual acuity or night contrast sensitivity order 100mg gyne-lotrimin visa. Mild gastrointestinal cheap 100 mg gyne-lotrimin fast delivery, dermato- logic, and neurologic side effects have been reported. High doses interact with and may enhance the effects of warfarin and antiplatelet drugs. Patients taking warfarin should be under medical super- vision if they are taking anthocyanins in doses greater than 170 mg/day. Mills S, Bone K: Principles and practice of phytotherapy, Edinburgh, 2000,Churchill Livingstone. Zadok D, Levy Y, Glovinsky Y: The effect of anthocyanosides in a multiple oral dose on night vision, Eye 13:734-6, 1999. It is also necessary for formation of fatty acids and is important for the metabolism of amino acids. Important reactions in which biotin participates include the following: glu- coneogenesis, by adding carbon dioxide to pyruvate to form oxaloacetate; fatty acid synthesis, by elongating the fatty acid chain; and energy produc- tion, by facilitating entry of both fatty acids and certain amino acids into the citric acid cycle. Intestinal bacteria syn- thesize biotin, but this is not believed to contribute much to the absorption of biotin. Raw egg white contains avidin, a protein that binds biotin and prevents its absorption in eggnog. Deficiency may manifest as dry flaking skin, depression, drowsiness, anorexia, myalgia, and anemia. There is speculation that biotin may facilitate blood sugar control in diabetes and reduce the risk of diabetic neuropathy. It has been suggested that 1000 to 1200 μg of biotin promotes the growth and health of hair and nails. Long-term use of antibiotics or anticonvulsants may increase the require- ment for biotin. However, if it occurs, it may lead to skin rash, loss of hair, high blood levels of cholesterol, and heart problems. Avidin, a protein found in high concentrations in egg white, binds biotin and prevents its absorption. A diet rich in raw egg white may cause biotin deficiency, which manifests as a red, scaly, facial skin rash, hair thinning, loss of hair color, and neurologic symptoms (e. Brighthope I: Nutritional medicine tables, J Aust Coll Nutr Env Med 17:20-5, 1998. Diefendorf D, Healey J, Kalyn W, editors: The healing power of vitamins, minerals and herbs, Surrey Hills, Australia, 2000, Readers Digest. It is used to relieve menopausal symptoms, premenstrual tension, and dysmenorrhea. The standard dose is 40 mg of black cohosh taken twice daily for menopausal symptoms, taken for 10 days before menses for premenstrual tension, and taken as required up to three times daily for dysmenorrhea. Remifemin, a standardized extract of black cohosh, is commonly prescribed as an alternative to hormone replacement therapy for menopause. However, a randomized clinical trial of patients with breast cancer receiving tamoxifen showed that black cohosh was not significantly more efficacious than placebo; however, menopausal symptoms, including the number and intensity of hot flashes, were reduced in both groups. In vitro black cohosh augments the antiproliferative action of tamoxifen; how- ever, it is contraindicated for women with estrogen-dependent breast cancer. It may augment the action of antihypertensive drugs, resulting in an unto- ward drop in blood pressure. Lieberman S: A review of the effectiveness of Cimicifuga racemosa (black cohosh) for the symptoms of menopause, J Womens Health 7:525-9, 1998. A diet rich in boron is believed to be beneficial for macromineral, energy, nitrogen, and reactive oxygen metabolism. Boron is thought to contribute to bone health by preventing cal- cium loss and enhancing bone maintenance by activating estrogen. Boron increases the ability of 17β-estradiol, but not parathyroid hormone, to improve trabecular bone quality in ovariectomized rats. A daily intake of 2 to 3 mg boron can be obtained from a 100-g serving of dried prunes. Boron may be particularly effective in protecting bone mass in persons with vitamin D, magnesium, and potassium deficiencies. Anecdotal suggestions that boron supplementation may reduce post- menopausal night sweats and hot flashes lack clinical support6; nonetheless, animal studies do suggest that the beneficial effects of hormone replacement therapy would be reduced in individuals with boron deficiency. In addition to potentially enhancing the response to estrogen therapy, a boron-rich diet is believed to improve psychomotor skills and cognitive processes. Gastrointestinal upsets, dermati- tis, and lethargy are likely to result from ingestion of boron in doses in excess of 100 mg daily. The stem and, to a lesser extent, the fruit of the pineapple contain a number of sulfhydryl-containing proteolytic enzymes collectively known as brome- lain. Bromelain has anti-inflammatory, anticoagulant, and antineoplastic effects and may enhance absorption of drugs, particularly antibiotics. Although its proteolytic fraction is important, many of the beneficial effects of bromelain are due to other factors. Bromelain’s anti-inflammatory action results from blocking bradykinin and its modulation of prostaglandin synthesis. Plasmin further suppresses inflammation by blocking the mobilization of endogenous arachidonic acid by phospholipases. Bromelain’s antineoplastic effects result from its ability to affect T-cell acti- vation, induce cytokine production in circulating monocytes, and enhance production of tumor necrosis factor and interleukins. Data indicate that bromelain can simultaneously enhance and inhibit T-cell responses in vitro and in vivo by means of a stimulatory action on accessory cells and a direct inhibitory action on T cells. One gram of bromelain standardized to 2000 mcu would be approximately equal to 1 g with 1200 gdu of activity or 8 g with 100,000 ru of activity. Bromelain has demonstrated therapeutic benefits in doses as small as 160 mg/day; how- ever, it is thought that for most conditions, best results occur at doses of 750 to 1000 mg/day. It may be used before surgery and in the treatment of acute thrombophlebitis, and bromelain in doses of 120 to 400 mg/day has been used to treat patients with myocardial infarction. Bromelain also appears to enhance the effect of cancer chemotherapy (in doses of 1000 mg/day) and antibiotics. However, because of its use as a meat tenderizer and a beer clarifier, bromelain is a potential inges- tive allergen. It may induce allergic reactions, especially immunoglobulin E–mediated respiratory problems, in sensitive individuals. Lotz-Winter H: On the pharmacology of bromelain: an update with special regard to animal studies on dose-dependent effects, Planta Med 56:249-53, 1990. Hinck G: The role of herbal products in the prevention of cancer, Topics Clin Chiro 6:54-62, 1999. Brakebusch M, Wintergerst U, Petropoulou T, et al: Bromelain is an accelerator of phagocytosis, respiratory burst and killing of Candida albicans by human granulocytes and monocytes, Eur J Med Res 6:193-200, 2001. A study of observed applications in general practice, Fortschr Med 113:303-6, 1995. Calcium and vitamin D reduce the decline of bone density in the elderly, but calcium probably does not attenuate menopausal bone loss. Calcium, the most abundant mineral in the body, is largely stored in bones where it provides structural strength. A lifelong dietary deficiency of calcium manifests in later life as osteoporosis, a major health problem in developed countries. Calcium intake is an important determinant of peak bone mass, and the risk of osteoporotic fractures is strongly influenced by bone mass. Low cal- cium intake has also been implicated in the development of several chronic conditions including hypertension, colon cancer, nephrolithiasis, and even premenstrual syndrome1; calcium supplementation has been used in the prevention of these diseases. Calcium is an essential component of antire- sorptive agent therapy for osteoporosis. It influences cell membrane and capillary permeability and is important for bone strength, blood coagulation, and electrical con- duction in nerves and the heart. Hormones, or first messengers, interact with cell membrane receptors and produce signals that generate second messen- gers inside cells. Calcium and the calcium-calmodulin complex, like cyclic adenosine monophosphate, can act as second messengers. When calcium combines with calmodulin, this small regulatory protein undergoes a con- formational change that allows it to interact with several enzymes, resulting in an increase in the catalytic activity of various protein kinases, including those that regulate membrane permeability to calcium and control the intra- cellular contractile proteins actin and myosin.

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Uses the Access to Leeds Programme purchase 100 mg gyne-lotrimin with visa, and accepts Access to Medicine Widening partcipaton courses from two colleges gyne-lotrimin 100 mg overnight delivery. No minimum graduate applicants) A level grades required but used they are used in pre-interview scoring gyne-lotrimin 100 mg. Healthcare-related work experience is not required but applicants cheap 100 mg gyne-lotrimin fast delivery, partcularly those who are borderline, must showcase refecton in Work experience whatever type of work they have encountered (voluntary, paid work in retail, catering, health or social care). Currently scored against non-academic criteria of healthcare awareness Personal statement and insight, caring contributon to the local community and writen communicaton skills. No specifc work experience is required though experience in addressing Work experience non-academic criteria is considered. Liverpool medical school gives special consideraton to Liverpool Scholars and students on the Realising Opportunites programme. There are also specifc reduced entry criteria for those who ofer non-traditonal courses Widening partcipaton such as Open University modules and locally approved Access courses. The medical school is pilotng the use of contextual data in the admissions process but it is not currently used in making ofers. Grades A in Chemistry and either Biology, Physics or Maths are required at Advanced Higher. Chemistry is required at Higher level as well as a second science plus a third subject. Three Internatonal Baccalaureate subjects are required at Standard level with a minimum of 5,5,5 including English. Widening partcipaton applicants and Manchester Access programme applicants are fagged. A minimum of 38 points, no subject should be graded less than 5 and with Internatonal Baccalaureate Higher level in Chemistry or Biology of at least grade 6. Not used prior or at interview, read prior to ofers being made but is not Personal statement scored. Emphasis on applicants being able to show a commitment to caring which can be accomplished in a number of ways other than in a hospital or Work experience General Practce setng e. Those made an ofer must pass a summer school and would have received a lower A level conditonal ofer. Assessment is based Personal statement on motvaton, experience of helping others, commitment, voluntary experience, extracurricular actvites, school/college contributon and supportng evidence in reference. Applicants who are fagged as widening partcipaton candidates by the Widening partcipaton university are considered in a separate group when selectng for interview. Internatonal Baccalaureate Candidates are required to take Chemistry and a second science (Biology or Physics) and/or Maths to Higher level. No specifc requirement, although some work experience (whether paid or Work experience voluntary) in the health or related sectors is valuable. Internatonal Baccalaureate 38–36 points overall including 6 in Higher level Biology and Chemistry. Selecton for interview considers contextual data and engagement in Widening partcipaton university widening partcipaton initatves. First A level to include Chemistry or Biology, second A level to include a secondary science subject (Chemistry, Biology, Physics or Maths). Any third A level can be taken excluding Further Maths, General Studies or Critcal Thinking. Three subjects are required, Internatonal Baccalaureate including Chemistry or Biology and one other science or mathematcal subject at Higher level, and three subjects at Standard level including Chemistry or Biology, if not ofered at the Higher level. Experience encouraged in healthcare-related Work experience environments and volunteering. Experience encouraged in healthcare-related Work experience environments and volunteering. We do not accept A Levels in Further Mathematcs, Critcal Thinking or General Studies. Interest in medicine, work experience/volunteering and outside Personal statement interests are all explored at interview. Applicatons from candidates with diferent backgrounds and of all ages are encouraged. Retakes may be considered on a case by case basis Highers for applicants over the age of 21 or graduates. Retakes may be considered on a case by case basis for applicants over the age of 21 or graduates. Personal statement is considered only if the applicant is invited to atend a Personal statement Selecton Day. However, applicants are expected to demonstrate what they have learned Work experience from their experiences of interactng with people in health or social care setngs. At Higher level, Chemistry and one other of Biology, Mathematcs Internatonal Baccalaureate or Physics at grade 7,6,6. Three passes at grade 6 at Standard level, including Mathematcs, Biology or English if not ofered at Higher level. Not scored but health-related work experience required for applicant to be Personal statement considered for interview. Applicants should have gained work or shadowing experience in a caring or health environment. Widening partcipaton applicants who have engaged with outreach projects at St Andrews, will be considered for interview if academic requirements are met. In additon, similar widening partcipaton Widening partcipaton candidates who do not meet the academic requirements may be considered for the Pre Med programme. Higher level: Combined score of 18, with at least two subjects at grade 6 or Internatonal Baccalaureate above including Biology and/or Chemistry. Any experience of providing care or help for other people which leads to an understanding of the realites of working in a caring profession. Candidates should be able to refect on how their work experience helped them to develop some of the attudes and Work experience behaviours essental to being a doctor. The medical schools is interested in what the applicant has learned about him/herself, other people and how care is delivered and received. Candidates are asked to provide further details of their work experience and/or confrmaton leters or references for verifcaton. Applicants are eligible for the Adjusted Criteria Scheme if applying from a school or college ranked in the botom 20% natonally in relaton to the average point score per full tme equivalent A Level student. In additon, the medical school runs a full of range of actvites including taster days, summer schools and work experience scheme for those from widening partcipaton backgrounds. Three Higher level subjects to add up to 19 points, including Internatonal Baccalaureate Biology and Chemistry with one at grade 7 and the other at grade 6. The Personal statement criteria assessed are: work experience, motvaton, teamwork, leadership etc. Any experience that involves working with other people, building relevant skills or gaining Work experience insight into healthcare professions. A sample of students are asked to provide further details of their work experience (approximately one third of candidates) and/or confrmaton leters or references for verifcaton. Widening partcipaton criteria are identfed and considered during assessment of the applicaton and selecton for interview. Many universites accept a degree in any subject, but some require the previous degree to be science- or health-related. It is a four- year accelerated degree in most cases, but in some universites it is a fve-year course. There is a preference for Work experience voluntary placements involving contact with patents. Those who do not hold these grades should be aware that their applicaton will be in direct competton with those who do. Academically compettve applicants will generally have at least 36 points with 6,6,6 at Higher level including Chemistry. Those who do not hold these grades should be aware that their applicaton will be in direct competton Internatonal Baccalaureate with those who do. A minimum of Chemistry must be taken at Higher level at 6, plus either two of the following at Higher or Standard level: Physics, Biology, Mathematcs. Personal statement Personal statement is reviewed prior to interview but not scored. Degree qualifcatons Applicants must have studied in one of the four listed insttutons and achieved at least a 2.

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The treatment experiences of 11 out of the 16 total participants who were affected by the culture of the medical profession appeared to be specifically influenced by economics purchase gyne-lotrimin 100mg online. More specifically buy gyne-lotrimin 100 mg visa, three participants reported feeling rushed by their doctors order gyne-lotrimin 100 mg fast delivery, eight participants had difficulty with accessing a doctor purchase gyne-lotrimin 100 mg with mastercard, and six participants had difficulty with accessing thyroid medication. Within Subtheme 3: Economics are the following subthemes: feeling rushed, access to doctor, and access to medication. Three out of the 11 participants whose treatment experiences were influenced by economics reported feeling rushed by their doctors. Autumn explained that in her experience, “Most [doctors] are just in and out doing as little as they possibly have to do,” and continued, “It would help if they weren’t so rushed. However, the organization of the healthcare system produces economic concerns that can act as obstacles to collaborative doctor-patient relationships. Due to financial and administrative concerns, doctors who are capable of communicating with their patients in a collaborative manner may be impeded by time constraints and limited resources for developing patient-centered practices (Balsa & McGuire, 2001; Dunn, 2003; Greenfield et al. As a result, the quality of the healthcare suffers and 222 traditional, hierarchical doctor-patient relationships persist (Levinson, 2011; Peters et al. According to Hearn (2006), doctors struggle to accommodate informed and active patients due to economic efficiency demands. Even doctors who support patient participation often behave in a paternalistic manner due to a heavy work load, staff shortages, and practical concerns such as reducing healthcare costs and avoiding malpractice lawsuits (Hearn, 2009; Sherwin, 2000). More specifically, from the micro-perspective, the healthcare system may ultimately reduce costs by allowing doctors to properly address their patients’ concerns and to collaboratively choose the most appropriate course of treatment; from the macro- perspective, because chronic illnesses are the primary cause of mortality worldwide and patient-centered approaches are fundamental to high-quality care, utilizing a patient- centered approaches may reduce the need for patients with chronic illness to see multiple providers. Research indicates that patient satisfaction and trust in one’s doctor are stronger predictors of patients’ commitment to the doctor-patient relationship than are the monetary costs of switching doctors (Platanova et al. In other words, patients who are not satisfied with or do not trust their doctors will seek new doctors even if switching results in a greater expense. Nevertheless, not all patients have equal access to the types of doctors they prefer. Eight out of the 11 participants whose treatment experiences were influenced by economics had difficulty with accessing a doctor. Shawna expressed frustration because her naturopath “cancelled [her] August recheck because [her naturopath] was too busy as a school nurse. Some participants expressed difficulty with accessing a doctor due to financial constraints. In Diane’s search for a doctor, the initial cost for seeing the doctor who listened to her and took her seriously was $400. While Diane was able to afford this fee, an out-of-pocket payment of $400 is too expensive for many patients. For example, Jenna shared, “I think [my doctor] could be a little more up to date but again, going through a free clinic I am limited. In addition to affecting patients’ access to doctor, financial constraints can also prevent patients from accessing their medication. Six out of the 11 participants whose treatment experiences were influenced by economics had difficulty with accessing thyroid medication. April reported switching from synthetic thyroid medication to natural thyroid medication in order to save money. She explained, “I used Synthroid 150 and Cytomel for almost 3 years but it was costing $60+ a month. When that happened, this doctor knew of nothing else to do but go back to Synthroid and did not understand when I was upset at that suggestion. However, as previously mentioned, numerous thyroid patients don’t feel well on synthetic thyroid medication and report feeling better taking natural thyroid medication (Armour thyroid is the most popular brand). Although some doctors prescribe natural thyroid medication, the general consensus of the conventional medical field is that Armour thyroid is outdated and Synthroid is better (Dommisse, 2009; Gaby, 2004). According to Gaby (2004), the negative reaction of the conventional medical community to natural thyroid medication “represents, at least in part, a biased attitude” (p. Dommisse (2009) contends that the medical community’s preference for synthetic thyroid medication is based upon biased research in which pharmaceutical companies are involved. Research indicates that diagnostic and treatment decisions are influenced by competing perspectives among pharmaceutical, medical, and insurance 226 companies (Hearn, 2009) and that patients fear their doctors’ recommendations for medication are influenced by pharmaceutical companies (Goff et al. Thus, considering that numerous patients report feeling well on natural thyroid medication, it seems that research on natural thyroid medication is warranted. Additional Findings As previously mentioned, I recognized some additional findings that were meaningful to some participants. Although these findings do not represent the treatment experiences of the participants as a whole, these data are nevertheless poignant examples of the phenomenon from individuals who have lived the phenomenon. Additional findings include a belief that the public is misinformed about thyroid disease (Diane), the experience of grief (Carla), the experience of empathy from one’s doctor (Michelle), and the experience of respect from one’s doctor (Michelle). More specifically, individuals with chronic pain and medically unexplained symptoms often report feeling discredited by not only their doctors, but their family and friends as well (Nettleton, 2006; Slade, Molloy, & Keating, 2009; Stenberg et al. Diane shared that she searched for over 30 years for the cause of her rapid weight gain and chronic fatigue. At one point, her symptoms were so severe that she was “bedridden and in danger of losing [her] job. Diane struggled and worked hard for her thyroid-related symptoms to be perceived as legitimate and worthy of attention. In sharing her thyroid disease treatment experience, one of Carla’s comments was indicative of grief. In sharing her experience, Carla reported that she used to be a body builder and had a successful career. However, Carla is now mobility impaired as a result of not receiving treatment in time for her “thyroid storm” 20 years ago. Before receiving radioactive iodine treatment for her thyroid storm, the doctor gave her an informed consent form and told her, “Sign it or die. She stated, “[My doctor] is very caring and listens to my needs…he has made clear that he is a good listener and has my best interest at heart. Research indicates that empathy is a vital component to an effective doctor- patient relationship and positive health outcomes (Houle et al. According to Gelhaus (2012a), empathy involves “…taking seriously the patient as a complete, distinct, unique human being…” (p. Although only four of the 16 total participants interviewed in this study specifically expressed experiencing a lack of empathy from their doctors, Michelle is the only participant to specifically indicate that she experienced empathy from her doctor. Furthermore, considering that nine of the 16 total participants believed their doctors did not take them seriously, it could be argued that at least nine participants had doctors who struggled with demonstrating empathy. Because empathy has the potential to reduce patients’ anxiety (Finset, 2012; Fogarty et al. Michelle indicated that she experienced respect from her doctor—the same doctor who provided her with empathy. When asked whether or not the gender of her doctor is important, Michelle responded, “I think he is so respectful of his patients that it does not matter if [it is a] male or female patient. However, Michelle is the only participant to specifically indicate feeling respected by her doctor. Feeling respected by one’s doctor is 229 associated with feeling heard and taken seriously (King et al. As previously discussed, patient-centered approaches engender trust in one’s doctor (Copeland et al. Trust, in turn, tends to result in patients’ willingness to share with their doctors and to consider their advice (Copeland et al. Thus, demonstrating respect to one’s patients is a vital component to establishing and maintaining effective doctor-patient relationships. Limitations of the Study Although the contributions of the participants add to the literature on the experience of thyroid disease and the doctor-patient relationship, findings should be considered with caution due to limitations of the study. Because this study was conducted via the Internet and I did not meet with the participants face-to-face, the participants’ age and gender could not be verified. The sample was self-selected from members of The Thyroid Support Group, which means that the sample may vary systematically and therefore may not be representative of most female thyroid patients. Because participants chose to participate in the study, they might have been enthusiastic about sharing their negative healthcare experiences, while patients who were satisfied with their treatment experiences had no interest in participating. In addition, the sample was mostly Caucasian, which reflects the findings of studies that indicate most Internet users tend to be Caucasian and have convenient access to a computer (e. As such, 230 the results of this study may not be generalizable to non-Caucasian individuals who do not have convenient computer access.

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